Plaque psoriasis is an inflammatory skin condition. Its main symptoms are raised patches and itchy skin. Those patches can be different colors depending on the color of your skin, and they can sometimes crack, drain, or bleed.

Psoriasis tends to be pink or red on people with light and fair skin tones, and the scale silvery white. On medium skin tones, it can appear salmon-colored with silvery-white scale. On darker skin tones, the psoriasis could look violet and the scale gray. Or it can also appear dark brown and difficult to see.

Psoriasis is one of the most common skin disorders in the world. According to one study, plaque psoriasis is the most common form of psoriasis.

Psoriasis is believed to be more common in individuals of European ancestry, but there’s limited research and information about managing and diagnosing psoriasis in Black, Indigenous, and People of Color. It’s considered a lifelong condition, but for many people, the condition sometimes goes quiet and sometimes flares up.

This article shows some examples of what plaque psoriasis can look like and explains how to tell if you have a mild, moderate, or severe case. It also discusses causes, symptoms, and treatments available if you have the condition.

Where the plaques are located, what color and size they are, and how much of your body they cover varies from person to person.

Plaque psoriasis is sometimes misdiagnosed as another skin condition, such as dermatitis and eczema.

You can read this article for more information about how psoriasis may appear in Black people.

Here are a few examples that show how plaque psoriasis may look on different skin tones:

If you’ve seen a dermatologist or another healthcare professional, you may have heard your case described as mild, moderate, or severe. The most commonly used scale for measuring severity is the Psoriasis Area Severity Index (PASI).

Doctors don’t just use the PASI when you’re first diagnosed. They may use it to check how well a treatment is working.

Here’s a look at some of the questions dermatologists use to determine how severe psoriasis is:

How much of your body is involved?

Healthcare professionals sometimes use a percentage to talk about how much of your body is affected by a skin condition. The percentage is sometimes called your body surface area involved, or BSA.

  • mild psoriasis: covers less than 3 percent of the body
  • moderate psoriasis: covers between 3 and about 9 percent of the body
  • severe psoriasis: covers 10 percent and more of the body

If you want to estimate that percentage yourself, you can use the size of your hand as a go-by. Most people’s hands are about 1 percent of the overall size of their body. About how many areas the size of your hand are covered by plaques? Health experts sometimes say that a case is severe if more than 10 percent of your body is affected.

How intense are your symptoms?

PASI and other scales look at these symptoms:

  • How deep is the color of the plaque? On some skin tones, plaques may be gray, dark brown, or purple. On other skin tones, plaques can go from pale pink to a deep, salmon-colored red.
  • How hard have the plaques become? Plaques are usually raised. Exactly how thick they are can be an indication of how severe the condition is.
  • How much scaling is there? Plaque psoriasis typically involves patches of gray or silvery-white scales. This is because the skin cells receive a signal to produce new skin cells too quickly. They build up and shed. More flaking usually indicates a more severe case.

PASI scores range from 0 to 72. A higher number means a more severe case.

Where are the plaques located on your body?

Plaques can show up in lots of different places on your body. Some locations cause more problems than others. Plaques on the scalp, for example, can sometimes be more severe than plaques on the rest of the body. Plaques on the face are often associated with a more severe condition overall. Psoriasis in genital areas may be considered more severe because it can affect your sex life.

For a more detailed look at psoriasis severity, you may want to read this article.

What is the personal impact?

When a healthcare professional talks about the intensity of symptoms, they often mean the degree to which symptoms interfere with your ability to function well.

For some, the condition causes embarrassment and discomfort. For others, symptoms keep them from being able to work, socialize, or participate in activities they love.

How to prepare for a psoriasis appointment

Whether you’re looking for medical help for the first time or you’re having a checkup, here are some strategies to help you speak clearly about your symptoms, goals, and needs.

  1. Find out if anyone in your family has an inflammatory skin condition like yours. Plaque psoriasis often runs in families.
  2. Keep a record of your symptoms in the weeks leading up to your appointment. Noting where plaques appear and what makes them worse may make it easier to come up with a treatment plan.
  3. If your mind goes blank when you’re in a medical office, jot down questions ahead of time.
  4. Use sentence frames to help you say what you need to say. Psoriasis Speaks offers this example: “I’ve been on my current treatment for [ time ], but I’m still experiencing [ symptom ]. I’d like to have [ result ] by [ date ]. How can we get there?”
  5. Mention other symptoms you’re having, because psoriasis often overlaps with other health conditions. A good treatment plan will address the big picture.

What are some causes and risk factors?

Your immune system is responsible for fighting illness and responding to injuries and irritation. Psoriasis happens when the immune system works too hard. It triggers inflammation in your skin and throughout your body.

Researchers aren’t sure exactly what causes plaque psoriasis. Your genes play a role. So does your family history. Other factors can increase your chances of developing psoriasis, including:

  • infections
  • injuries
  • smoking
  • some medications
  • overweight

Psoriasis can sometimes flare. Flares are often triggered by:

  • stress
  • injuries to your skin, including shaving nicks, tattoos, and piercings
  • cold, dry weather
  • too much time in air-conditioned or heated spaces
  • sunburn
  • drinking alcohol too often
  • changes in medication
  • infection

Most dermatologists will start with the simplest and least invasive treatments. First-line treatments usually include:

  • topical corticosteroids
  • vitamin D analogs
  • salicylic acid ointments

If you’re using topical skin treatments, it’s important to apply them exactly as instructed. It’s also important to avoid irritants and triggers in your environment.

Oral systemic medications

A class of oral medications called disease-modifying antirheumatic drugs (DMARDs) can slow down or stop certain conditions that are caused by an overactive immune system. These include:

Here’s more information about oral medications used to treat psoriasis.

Injectable or intravenous (IV) medication (biologics)

Drugs classified as biologics help to calm your immune system. Biologics block the action of a specific type of immune cell called a T cell, or block proteins in the immune system, such as TNF-alpha, interleukin 17-A, or interleukins 12 and 23.

Here are some examples of biologics used to treat psoriasis:

Researchers studying psoriasis have identified disparities in care between white people with psoriasis and Black people with psoriasis. They found that Black people with psoriasis were 69 percent less likely to be prescribed biologics as a treatment for psoriasis than white people. These researchers suggest that this disparity is related to both financial and racial barriers.

Other studies have suggested education about all available treatment options and improving access to care for psoriasis would help address this disparity.

Natural remedies

Because it’s a chronic condition, many people with plaque psoriasis will try alternative and natural treatment methods. One method that has gained significant attention in the psoriasis community is the mud and salt of the Dead Sea.

Thousands of people a year invest in expensive Dead Sea skin treatments or vacations to attempt to heal their psoriasis. The scientific evidence is limited regarding the effectiveness of these treatments, but many believe it helps.

Light treatments

Light therapy, also called phototherapy, is a common treatment for plaque psoriasis. Because light therapy is nonpharmaceutical, it’s a popular choice before systemic medications.

Some people are able to find relief from symptoms and improvement in psoriasis plaques through regular limited sessions of sun exposure. Others fare better using a special light machine. Due to skin cancer risks, controlled phototherapy is generally recommended by dermatologists over sun exposure at regular intervals. Studies have shown that people with dark skin tones may need higher doses of phototherapy than people with light skin tones.

Check with your dermatologist before treating your psoriasis through exposure to sunlight. Too much sun exposure can burn your skin and may actually make plaque psoriasis worse.

To learn more about psoriasis treatment options, you may find this article helpful.

Most doctors and nurses can tell if a scaly or rough patch of skin is psoriasis. Sometimes you may need a biopsy or a visit with a dermatologist. During your visit, make sure to point out all of your abnormal patches of skin.

Locations

The most commonly affected parts of the body include the elbows, knees, and scalp. Most people with plaque psoriasis will develop patches in these areas. Some will also have psoriasis patches on other areas of the body.

Changes

The location of plaque psoriasis can change as patches heal. New patches may appear in different locations during future attacks. Plaque psoriasis affects everyone differently. No two people will experience the same symptoms.

Patches can show up in places that seem random. Some patches may cover large portions of the body, while others may be no larger than a dime.

Once a person has developed psoriasis, it may appear in a number of different forms and in different areas of the body.

Hair and scalp

According to the American Academy of Dermatology, at least 50 percent of people with plaque psoriasis will experience a bout of scalp psoriasis. Plaque psoriasis on the scalp may require different treatments than plaque psoriasis on other parts of the body.

Medicated ointments, shampoos, and careful removal of scales can help treat scalp psoriasis. Sometimes, systemic medications must be used to clear plaque psoriasis on the scalp.

If plaques are left untreated, they can bleed, ooze, and sometimes become infected. Some skin types have lasting pigment changes even after plaques have healed. Eventually, these color changes often go away, but it can be distressing while they’re present.

Psoriasis is often associated with other health conditions. Some of them are serious. The most common illnesses that overlap with psoriasis are:

  • psoriatic arthritis
  • metabolic disorders such as insulin resistance and obesity
  • diabetes
  • heart disease
  • kidney disease and kidney damage
  • irritable bowel disorders
  • uveitis or inflammation of the eye
  • liver disease
  • substance use disorders
  • lung diseases
  • depression, anxiety, and other mental health conditions

Many of these conditions stem from problems in the immune system. Psoriasis doesn’t cause these conditions, but often occurs at the same time in the same people.

There’s no cure for plaque psoriasis at this time, but there are treatments that can significantly improve symptoms and reduce flares.

The condition is considered chronic. This means that even with effective treatment, you may experience periods where symptoms reappear.

There’s no evidence that plaque psoriasis worsens as you age. Taking good care of your skin can still be helpful, especially because your skin can become thinner and more prone to injury with age.